The role of a palliative care intervention in moderating the relationship between depression and survival among individuals with advanced cancer.

Abstract

Objective Randomized controlled trials (RCTs) of early palliative care interventions in advanced cancer have positively impacted patient survival, yet the mechanisms remain unknown. This secondary analysis of two RCTs assessed whether an early palliative care intervention moderates the relationship between depressive symptoms and survival. Methods The relationships among mood, survival, and early palliative care intervention were studied among 529 advanced cancer patients who participated in two RCTs. The first (N=322) compared intervention vs. usual care. The second (N=207) compared early vs. delayed intervention (12 weeks after enrollment). The interventions included an in-person consultation, weekly nurse coach-facilitated phone sessions, and monthly follow-up. Mood was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Cox proportional hazard analyses were used to examine the effects of baseline CES-D scores, the intervention, and their interaction on mortality risk while controlling for demographic variables, cancer site, and illness severity. Results The combined sample was 56% male (mean = 64.7 years). Higher baseline CES-D scores were significantly associated with greater mortality risk (HR = 1.042, 95% CI 1.017 to 1.067, p = .001). However, participants with higher CES-D scores who received the intervention had a lower mortality risk (HR = .963, CI 0.933–0.993, p = .018) even when controlling for demographics, cancer site, and illness-related variables. Conclusions This study is the first to demonstrate that patients with advanced cancer who also have depressive symptoms benefit the most from early palliative care. Future research should be devoted to exploring the mechanisms responsible for these relationships.

Effect of an Educational Palliative Nursing Interventions on Selected Outcomes among Patients Having Advanced Cancer

“…This came in accordance with Prescott et al, (2017) who reported that patients with advanced cancer who also have depressive symptoms benefit the most from early palliative care. Also Rosenstein, (2011) reported that the pharmacotherapy of depression in patients with advanced cancer should be guided by a palliative care approach focused on symptom reduction, irrespective of whether the patient meets diagnostic criteria for major depression.…”

Cultural Adaptation and Open Pilot of Meaning-Centered Psychotherapy for Puerto Rican Patients with Advanced Cancer

“…This already high cancer incidence is accompanied by the even higher risk in Latinos of experiencing elevated levels of depressive symptoms, emotional distress, and reduced quality of life when compared to other minority ethnic groups [3,4]. Further, per our recent systematic review, a lack of participation of Latinos, including Puerto Ricans, on the development of psychosocial intervention was found [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Follow the trail: Using insights from the growth of palliative care to propose a roadmap for cancer rehabilitation

“…The evidence base continued to expand beyond these seminal studies and demonstrated positive effects on illness communication, adaptive coping, prognostic awareness, treatment decision making, end‐of‐life care, caregiver outcomes, and cost‐effectiveness . As the science matured, palliative care researchers were able to identify mediators and moderators of the beneficial effects of palliative care …”

“…65 As the science matured, palliative care researchers were able to identify mediators and moderators of the beneficial effects of palliative care. 59,[66][67][68] By 2016, the evidence base had grown enough to allow meta-analyses to be conducted on palliative care clinical trials. First, Kavalieratos et al 69 evaluated 43 studies that tested at least 2 domains of palliative care (eg, depression and quality of life).…”